Pancreatic cancer (cancer of the pancreas) mainly occurs in people aged over 60. If it is diagnosed at an early stage, then an operation to remove the cancer gives some chance of a cure. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer.
What is the pancreas?
The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). The shape of the pancreas is like a tadpole, and so the pancreas has a head, a body and a tail. The head section is nearest to the duodenum (the part of the gut just after the stomach).
The pancreas makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny ducts (tubes). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the duodenum. The enzymes are in an inactive form in the pancreas (otherwise they would digest the pancreas). They are activated in the duodenum to digest food.
Groups of special cells called islets of Langerhans are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed (secreted) directly into the bloodstream to control the blood sugar level.
The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile also passes into the duodenum and helps to digest food.
What is pancreatic cancer?
Pancreatic cancer is relatively uncommon. It develops in about 1 in 10,000 people each year in the UK. There are several types of pancreatic cancer, but more than 9 in 10 cases are ductal adenocarcinomas.
Ductal adenocarcinoma of the pancreas
This type of cancer develops from a cell which becomes cancerous in the pancreatic duct. This multiplies and a tumour then develops in and around the duct. As the tumour enlarges:
It can block the bile duct or the main pancreatic duct. This stops the drainage of bile and/or pancreatic fluid into the duodenum.
It invades deeper into the pancreas. In time it may pass through the wall of the pancreas and invade nearby organs such as the duodenum, stomach or liver.
Some cells may break off into the lymph channels or bloodstream. The cancer may then spread to nearby lymph nodes or spread to other areas of the body (metastasise).
Other types of pancreatic cancer
There are some rare types of cancer which arise from other types of cells within the pancreas. For example, cells in the pancreas that make insulin or glucagon can become cancerous (insulinomas and glucagonomas). These behave differently to ductal adenocarcinoma. For example, they may produce too much insulin or glucagon, which can cause various symptoms.
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. (See separate leaflet called What causes cancer? for more details.)
Many people develop cancer of the pancreas for no apparent reason. However, certain risk factors increase the chance that pancreatic cancer may develop. These include:
- Ageing. It is more common in older people. Most cases are in people aged over 60.
- Diet. Eating a diet high in fat and meat seems to increase the risk.
- Chronic pancreatitis (persistent inflammation of the pancreas). Most cases of chronic pancreatitis are due to drinking a lot of alcohol.
There are other less common causes.
- Diabetes. Note: diabetes is common and the vast majority of people with diabetes do not develop pancreatic cancer.
- Chemicals. Heavy exposure at work to certain pesticides, dyes and chemicals used in metal refining may increase the risk.
- Genetic and hereditary factors
Most cases of pancreatic cancer do not run in families. However, some families have a higher incidence of pancreatic cancer than average. It is thought that about 1 in 10 pancreatic cancers are due to inheriting an abnormal gene. See your doctor if you are concerned that pancreatic cancer is common in your family.
You may be offered screening tests with the aim of detecting pancreatic cancer at an early stage when the chance of a cure is high. A study group based at Liverpool University, called European Registry for Familial Pancreatic Cancer and Hereditary Pancreatitis (EUROPAC) is researching the causes of pancreatic cancer. EUROPAC co-ordinates a national study into screening for pancreatic cancer in those at high risk. See contact details at the end of the leaflet.
What are the symptoms of pancreatic cancer?
Symptoms of a blocked bile duct:
In about 7 in 10 cases the tumour first develops in the head of the pancreas. A small tumour often causes no symptoms at first. As the tumour grows it tends to block the bile duct. This stops the flow of bile into the duodenum which leads to:
- Jaundice (yellow skin caused by bile seeping into the bloodstream due to the blockage).
- Dark urine – caused by the jaundiced blood being filtered by the kidneys.
- Pale faeces – as the faeces contain no bile which causes their normal brown colour.
- Generalised itch caused by the bile in the bloodstream.
- Pain is often not a feature at first. Therefore a painless jaundice that becomes worse is often the first sign of pancreatic cancer. Nausea and vomiting are also fairly common symptoms.
As the cancer grows in the pancreas, further symptoms that may develop include:
- Pain in the upper abdomen. Pain can also pass through to the back.
- You may feel generally unwell and lose weight. These symptoms are often the first to develop if the cancer develops in the body or tail of the pancreas (when the bile duct is not blocked).
- You may not digest food very well, as the amount of pancreatic fluid will be reduced. This can cause smelly pale faeces and weight loss.
- Rarely, diabetes develops if nearly all the pancreas is damaged by the tumour.
- Rarely, a tumour can trigger inflammation of the pancreas – acute pancreatitis. This can cause severe abdominal pain.
- If the cancer spreads to other parts of the body, various other symptoms can develop.
The most common types of cancer of the pancreas are exocrine tumours. The symptoms vary depending on where the cancer is in your pancreas – in the head, body or tail. Common symptoms include
- Pain in the stomach area or back
- Weight loss
- Symptoms can be vague – do see your GP if you are at all concerned. They won’t think you are bothering them unnecessarily.
About 7 out of 10 people with pancreatic cancer first go to their doctors because they have pain. Pain is more common in cancers of the body and tail of the pancreas. People describe it as a dull pain that feels as if it is boring into you. It can begin in the stomach area and spread around to the back. The pain is worse when you lie down and is better if you sit forward. It can be worse after meals. Some people may only have back pain. This is often felt in the middle of the back, and is persistent.
About half of patients have jaundice when they first go to their doctors. Most of these people will have pain as well. Around 1 in 10 people will have painless jaundice.
Jaundice is yellowing of the skin and whites of the eyes. The urine is darker than normal and bowel motions may be lighter in colour. Jaundice is more common with cancer of the head of the pancreas because the tumour blocks the bile duct. This tube carries bile into the duodenum.
If it is blocked the bile ends up in your bloodstream. It is passed out in your urine rather than through the bowel. Bile contains a lot of yellow pigments so it turns the skin yellow. Jaundice is a common symptom of many liver and gallbladder diseases. It is often easier to spot in the whites of the eyes rather than the skin.
- Weight loss
People diagnosed with pancreatic cancer may have recently lost a lot of weight (at least 10% of their total body weight) for no apparent reason. This symptom is more common in cancers of the head of the pancreas.
There are other symptoms that you can have with cancer of the pancreas. You may have any of these symptoms from before you are diagnosed. Or you may develop them later. Of course, you may not have all of them. Not everyone has every symptom. These non specific symptoms of pancreatic cancer include
- Bowel changes
- Fever and shivering
- Blood clots
Some people diagnosed with cancer of the pancreas are found to be newly diabetic. Some have been diagnosed with diabetes within the previous year. If you have diabetes you are not producing enough insulin. So there is too much sugar in your blood. The sugar is passed out of the body in the urine and takes a great deal of water with it. This causes
- Passing a lot of urine
- Weight loss and hunger
You may have itching if you have bad jaundice. The increased bile salts in the bloodstream cause itching in the skin.
You may feel or be sick because you have jaundice or an inflamed pancreas. Both these conditions upset the delicate chemical balance of the body, which can make you sick. You may also be sick if the cancer, or inflammation around it, is beginning to block the duodenum. This will stop digested food from passing through to the small bowel. Due to sickness, you may have a loss of appetite which can result in weight loss.
- Bowel changes
If your pancreatic duct is blocked, you may develop a symptom called steatorrhoea. This means fatty stools (poo). You may pass frequent, large bowel motions that are pale coloured and smelly, and are difficult to flush away. These bowel disturbances can mean that you are not absorbing your food properly. So this may be a cause of weight loss.
- Fever and shivering
You may have a temperature from time to time because you have jaundice or an inflamed pancreas. When your temperature is high you may feel cold and shivery.
Indigestion causes heartburn, bloating and sickness. It is a common problem in the general population, and for most people it isn’t a sign of cancer. But if it is persistent or isn’t getting better with medication, you should go back to see your doctor.
- Blood clots
Occasionally, pancreatic cancer is linked to blood clots. They may form in the deep veins in the legs for example, or in smaller veins anywhere on the body. Sometimes the clots will disappear and then develop somewhere else in the body. Common symptoms of a blood clot include
- Pain, redness and swelling around the area where the clot is.
The area around the clot may feel warm to touch
How is pancreatic cancer diagnosed and assessed?
There are many causes of jaundice and of the other symptoms listed above. For example, a blocked gallstone or hepatitis (liver inflammation). Therefore, some initial tests are usually arranged if you develop jaundice or the other symptoms listed above. Typically, these include an ultrasound scan of the abdomen and various blood tests. These initial tests can usually give a good idea if the cause of jaundice is a blockage from the head of the pancreas.